Trauma-Informed Care, Neuroplasticity and Mindfulness

The entire series in January will be focusing on how trauma-informed care can help adults overcome the effects of adverse childhood experiences (ACEs).

However, to understand the process of healing, we must first explore what happens to the brains of traumatized children, and how neuroplasticity and mindfulness aid us in healing.

Childhood Trauma, Who is Affected?

According to a report published in 2012 by the National Center for Mental Health Promotion and Youth Violence, 60% of adults report they experienced trauma in their childhood.

In yet another report published by the National Center for Mental Health Promotion and Youth Violence, the traumatic experiences children endure are many and varied. Sexual, emotional and mental violence plus neglect are the abuses generally thought of as being the causes of complex post-traumatic stress disorder. However, there are other events children experience which can cause them to develop CPTSD symptoms.

Exposure to and the witness of violence against others, living in a war zone or neighborhood with constant violence and living through a natural disaster are also adverse childhood experiences.

The results from being exposed to ACEs is long and tragic. According to a paper published in 2016 by Child and Adolescent Psychiatry and Mental Health (Bielas, Barra, et al., 2016), the mental health disorders most closely associated with adverse childhood experiences are as follows:

Post-traumatic stress disorder

Anxiety and anxiety disorders

Depression

Suicidal behaviors

Antisocial behavior

Dissociative Disorders

Borderline personality disorder

The list above is only partial, having not room enough in this article to incorporate the other mental and physical consequences later in adulthood from adverse childhood experiences.

ACEs, and the Developing Brain

Traumatic experiences do not just harm a child emotionally; they also harm their developing brain. Experiencing child abuse early in life can dramatically change the number of neurons in the brain and can decrease the ability for the neuron’s to communicate with one another.

In a book written by Pablo Nepomnaschy and Mark Flynn on page 373, there is a discussion of why structures in the brains of young children are so severely affected. The changes are caused by the constant exposure to the developing brain to the stress hormone cortisol. Cortisol, sent from the amygdala when it recognizes a threat, readies our bodies for the fight/flight/freeze response.

When subjected to adverse childhood experiences, cortisol is continually pumped into the bodies of children and the child’s brain chemistry never returns to baseline. Cortisol is poisonous to developing brains causing damage to vital brain structures which are unalterably changed for life.

Unfortunately, the amygdala and hippocampus are affected the most, and these structures are responsible for our ability to control our emotions and our memory.

The Changes from ACEs to the Amygdala and Hippocampus

When humans become frightened, a complex cascade of events occurs in the brain and body.

The fear response begins in the amygdala, a small almond-shaped section of nervous tissue which is located deep within the brain. The amygdala is responsible for emotions and remembering danger so we can avoid it in the future.

This tiny structure is the first part of our brain to recognize danger, and when it does, it produces cortisol. The amygdala alerts the body to the danger and readies it for the fight, fight or freeze responses.

The hippocampus is a small seahorse-shaped structure which is also located deep inside our brain. This structure plays a vital role in memory formation and storage.

Several papers have been written noting the significant changes in the size of the amygdalae and hippocampi of people living with dissociative identity disorder (DID) which is linked closely to complex post-traumatic stress disorder (CPTSD). This paper offers the following conclusion:

“Hippocampal volume was 19.2% smaller and amygdalar volume was 31.6% smaller in the patients with DID, compared to the healthy/ neurotypical subjects. The ratio of hippocampal volume to amygdalar volume was significantly different between groups [as compared to healthy/ neurotypical subjects in the study] .”

The reason for mentioning how ACEs change these two structures is because they are directly related to the formation of CPTSD and its symptoms.

A smaller amygdala alters how our ability to react to danger, as we may perceive danger where there is none. Our body reacts viscerally based only on a smell, sight or sound which throws our body into fight/flight/freeze. We also may experience flashbacks and panic attacks.

Also, because our hippocampus is smaller, our ability to recognize what we are hearing, seeing or smelling today is mixed up with what we experienced in the past. For instance, we might hear firecrackers and flashback to the time when we were children and witnessed gun violence.

There is research showing that other regions of the brain, including the corpus callosum, are damaged also, which makes treating complex post-traumatic stress disorder complicated.

The Effect of Synaptic Pruning and Adverse Childhood Experiences

Adverse childhood experiences dramatically change the connections between and the number of neurons in the developing brain. These neuronal changes can change our personalities and perceptions because pruning rids the brain of synapses which are not needed.

Which synapses we rid ourselves of is based on our experiences, and ACEs hijack our experience-based pruning. The loss of the of the brain cells which should have been used in developing healthy connections to others leaves us emotionally scarred and with deficits in our world view.

During early childhood, new skills are picked up quickly because we are born with over 100 trillion brains cells which are anxious to absorb information from our environment and our experiences.

The learning of language is one good example of how our minds can learn and how that time is limited.

When babies are born, they do not distinguish between languages nor the accents within them. Our inability to distinguish languages and accents is automatic, as we are hardwired in utero to listen to those around us. At birth we cannot tell one language from another.

Children who are born into bilingual households learn both languages at the same time at the same rate as those born into monolingual homes. However, if children are not exposed to language by their caregivers, the synapses we are born with which develop our ability to speak are pruned away and lost forever.

A horrible example of how we lose a vital skill through synaptic pruning is the story of Genie (not her real name). Genie is an American feral child who was the victim of severe neglect and had been kept in total isolation from 20 months until she was thirteen-years-old.

When the authorities found her, she was incapable of uttering a single word. Specialists tried to teach her how to speak, but she has only been able to learn nouns and form rudimentary sentences.

The reason she could not learn a language is that her brain had pruned away the synapses necessary for acquiring language.

Thankfully, synaptic pruning is a normal part of brain health and is not a limitation to most neural plasticity.

What is Neuroplasticity?

Until the 1960s, mental health professionals and researchers believed that once we reach adulthood, our brains do not change. It was thought that after early adulthood what we had at that time regarding brains structure and size were permanent.

Norman Doidge wrote about the ancient belief that the brain could not grow and change and how these beliefs came from observations that people with brain damage often couldn’t recover. Physicians were unable to see the activities that occur microscopically in the brain, and this limitation kept researchers focusing on early childhood changes and not on what happens in adulthood.

However, modern research shows that the brain is not static after early adulthood, but a vibrant and changing organ which changes as we encounter new experiences.

Neuroplasticity is the term researchers gave to the way brain cells (neurons) grow and change because they are malleable (plastic).

Neurons change regularly and are shaped by our experiences. This helps adults learn, adapt, and remember. Every time we experience something new, a new neural pathway forms, and if repeated, reinforce and strengthen the connections between brain cells.

So, neuroplasticity happens throughout our lives based on our experiences which either strengthen or weaken our neural connections. What we don’t use will be pruned away. However, there is a way neuroplasticity can be harnessed to successfully mitigate the effects of adverse childhood experiences on our adult lives.

Mindfulness.

Just What is Mindfulness?

Mindfulness does not have one definitive definition. However, the best answer is that mindfulness aids us in paying attention in a non-judgemental fashion to all our thoughts and actions, without focusing unnecessarily on faults and flaws.

Mindfulness is also a technique anyone can learn and involves making a special effort to notice what is happening around you in the now. This skill can help us to:

Become more self-aware

Feel calmer and less stressed

Feel able to make choices in responding to our thoughts and feelings

Cope with intrusive thoughts

Another term for mindfulness, first coined by Daniel J. Siegel and the MARC at UCLA, is mindful awareness. By using intentional, directed focus and paying close attention to the “now” one becomes aware of intrusive thoughts allowing for changes to thought patterns.

By paying more attention to the present moment, we can lower the stress hormones which are responsible for the hyperarousal which accompanies CPTSD. When these chemicals in our bodies decrease, we become less anxious, and we can better incorporate new ideas and new ways of thinking about ourselves.

Mindfulness and Neuroplasticity

Neuroplasticity is our greatest ally when it comes to healing from complex trauma.

A training post made in the Journal of Trauma Nursing, published in June 2018, offered a breakdown of how mindfulness changes the brain. They record that researchers have been studying via magnetic resonance imaging (MRI), how mindfulness causes new neuro-pathways to form.

Mindfulness changes how we process incoming signals from the environment and helps to desensitize our reactions to them. If one practices mindfulness regularly, eventually our hyperattentive amygdalae will calm and we will no longer have the classic complex post-traumatic stress disorder response to triggers.

There are results from other research which found people who practice mindfulness make new neural connections between important prefrontal brain structures, which not only stabilizes arousal to stimuli, but also reduces harmful risk-taking.

Through practicing mindfulness, one can learn to remain in the present. Our brains will make new neuro-pathways through mindfulness which will allow us to remember the calm we find through it, and thus reduce our anxiety. We learn how to be less hypervigilant, and for our mind to be less reactive to triggers than we once were.

In Conclusion

While adverse childhood experiences change our brains in unalterable ways, this does not mean new neuropathways cannot be formed to help us live well. By using mindfulness techniques, neuroplasticity allows us to create new habits and therefore a a new life, despite the lingering effects of the events which caused us to form complex post-traumatic stress disorder.

Next week we will examine resiliency building and how it can help us travel down the road less taken to healing.

4 Comments

Lari
on January 29, 2019 at 3:48 pm

I have the book – “The Brain that Changes Itself: Stories of Personal Triumph From the Frontiers of Brain Science” written by Norman Doidge, which I purchased in August of 2017. Interesting book, but does not, in my opinion, address the process of DID nor the triumph over it!

Thank you for your comment, Lari. It’s Shirley. I kind of help out here too! I might need to check out the book you mentioned. It sounds great for an amateur neurologist like me. We enjoy your comments very much and having you read here, my blog and from other websites, I’m involved with. Shirley

Thank you for this article; especially so I can pass it along to family members. As someone struggling deeply and daily with complex PTSD (and every other fx listed as well as many chronic invisible illnesses) due to ACEs and additional traumatic events it’s gteat to find this foundation, new articles about neuroplasticity and again the ability to combat the struggle with mindfulness among other things, to wire new healthy connections. If only there were more support in doing this as even finding a trauma-informed therapist is difficult not to mention forcing yourself to practice mindfulness in the midst of daily struggle. Centers for trauma victims to attain these services funded by charitable organizations, NIH grants, and the like would be amazing; something I’d hope to be a part of in using the services and later serving others. God-willing insurance to actually pay for such a thing would be a miracle other than the non-specific tx centers; the far & few btwn and mildly helpful PHPs/IOPs which are difficult to get to because of location, scheduling & insurance, of course…amidst the daily struggle. Actual PTSD focused centers that aren’t focused on veterans; as their needs are there but the awareness is greater as well as support versus the many “others,” that get asked, “were you in the military” and feel a need to explain your trauma and the shame that goes with it. I look forward to reading more; continue with books I have; keeping the hope alive; and trying to do one thing a day minimum that is mindful. Because sometimes that’s all you can do or expect from yourself or the shame creeps in.

Thank you for your wonderful comment. I’m the author of the piece you are speaking about, Shirley.

I realize how hard it can be to find a trauma-informed therapist when you live in a rural area. I too live in one, among the corn and bean fields of Illinois. I live halfway down the state (and it is a long one) from Chicago. So much of our money in Illinois filters up to Chicago that we hear in the middle and lower sections of the state don’t receive enough funding for mental health. The result is thousands of people who need trauma-informed care struggling to meet our needs. Going to a VA clinic is a great idea. I hadn’t thought of that before. But, as you said, you must find one that accepts non-Veterans and that is equally as tough in a rural area.

Chin up though! Through voices like yours, mine and the CPTSD Foundation we are going to change the lack of parity in trauma-informed mental health care! We just need to keep fighting and help the people in the United States see that an ounce of prevention truly does beat an ounce of cure in terms of cost and impacted lives.

In the meantime, we will support each other! Keep reading and look into the services Athena (the President of CPTSD Foundation) offers. She has a YouTube talk every week that is free. You can check that out first and see if you like it. She answers questions from attendees and they encourage each other.

Thank you, again, for reading my work. It makes me feel wonderful that I have touched a life! Shirley

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